Provider Demographics
NPI: | 1689373128 |
---|---|
Name: | OZARK TRI-COUNTY HEALTH CARE CONSORTIUM |
Entity Type: | Organization |
Organization Name: | OZARK TRI-COUNTY HEALTH CARE CONSORTIUM |
Other - Org Name: | ACCESS FAMILY CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DONALD |
Authorized Official - Middle Name: | MICHAEL |
Authorized Official - Last Name: | MCBRIDE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 417-451-9450 |
Mailing Address - Street 1: | PO BOX 758 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEOSHO |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64850-0758 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 417-451-9450 |
Mailing Address - Fax: | 417-451-8903 |
Practice Address - Street 1: | 301 BIG SPRING DR |
Practice Address - Street 2: | |
Practice Address - City: | NEOSHO |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64850-1700 |
Practice Address - Country: | US |
Practice Address - Phone: | 417-782-6200 |
Practice Address - Fax: | 417-782-6210 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-02-23 |
Last Update Date: | 2023-09-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |